At the September 2003 Nursing Leadership – Cutting to the Core Conference, I put the case that nursing leaders consider themselves as ‘sense-makers’. Drawing on my conference paper and workshop, I outline here what sense-making is, why it is important and how to express sense-making capabilities. What is sense-making?

Three factors that make workplaces dynamic are complexity, ambiguity and uncertainty. Uncertainty invites doubt and reduces our sense of control. People wonder who to believe and what things mean.

By sense-maker I mean a person who has the flexibility to give meaning to complexity, and to reduce ambiguity and uncertainty. The sense-making leader gives coherence to complex issues. This is the antidote to uncertainty because it gives some sense of control. Meaning provides a guide to action. Many prefer to look to others to define what is real, what is fair, what should count, where they should be going. Leaders, by answering these questions, alleviate the burden of not knowing.

Whether we are a leader of the profession or a leader in a specific workplace, leading is a succession of moments, in which we help others make sense out of what’s happening. Whether events are within our control or not, what we do control is influencing how such events are seen and understood. This is the art of managing meaning. Five skills of the sense-maker

Sense-makers draw on a range of language, cognitive and interpersonal skills to manage meaning and build understanding.

• In order to make sense of a situation for others we first have to make sense for ourselves. Nursing leaders as sense-maker therefore need self-knowledge about their own thinking processes, beliefs and values.
• Skill in Framing. The sense-maker uses language to encourage the acceptance of one meaning over another, to get to the heart of a matter, to make linkages between seemingly unrelated matters. They place a frame of meaning around an issue so that it makes sense to others. For example, is a proposed change a threat, a disaster or an opportunity?
• Being astute judges of others’ framing. Leaders need to be able to discern how other people are making sense of their world and to work with this diversity. Nursing leaders are able to tap hidden premises and assumptions and undrawn conclusions that drive others’ thinking. They are able to bring these assumptions to the surface for discussion and clarification.
• Clarifying expectations. Unclear expectations are a key source of uncertainty. Leaders clarify expectations about the nature of work, the future, standards, boundaries.
• Most critically, sense-makers create a vision of the future, they articulate dreams.

Three qualities of the sense-making leader

Sense-making leaders reflect these qualities:

• Optimism. Sense-makers know that bad times will pass. They keep events in perspective, knowing that some things are beyond their control.
• Ambition. Leaders want to achieve their goals and realise their dreams.
• Resilience, persistence, and reluctance to take ‘No’ for an answer.

When you combine these skills and qualities you have nursing leaders who are influential. They know where they are heading and are willing to step forward and speak up. They provide a voice – defining a vision, identifying issues, proposing ways forward. Why sense-making is important for the nursing profession

There are at least three reasons why exercising sense-making is vital for the nursing profession.

Firstly, nurses mix with a broad range of people who need to understand the profession and where it is heading. In addition to colleagues, boards, patients and other health and medical professionals, there are ministers, unions, industry groups, the media and the general public. A daunting list!

These groups need to understand what the nursing profession is about and where it is heading. And they need to hear that vision often. Understanding a vision does not come from a one-time utterance. It must be uttered daily, continually, over and over.

Secondly, these groups have their own interpretations of what nursing is about. They’ll operate on their own assumptions and expectations about what nursing is, has been, should be, will be. These may or may not match what you’d like them to be. In the absence of having meaning managed for them differently, people will continue to operate as they always have. Possibly to your detriment. Nursing leaders need to manage the meaning of the profession as an ongoing role.

And thirdly, the profession is competing with other sense-makers, who may seem like complementary sense-makers but whose agenda may conflict with the nursing profession’s interests. Or their agenda may receive more attention even though the issues are complementary. For example, I read a substantial newspaper story recently about a proposal that older GPs receive an incentive to continue practicing full-time. The AMA president told a Senate committee that ‘We are currently sitting in one of the biggest workforce crises this country has ever seen, and it’s only just started.’ This is a meaning frame not unique to GPs. Yet in the absence of other voices the public may see it as a problem of only one profession. How do you express sense-making capabilities?

Here are six ways nursing leaders can act as a sense-maker.

• Know what you stand for in terms of purpose, values and standards. This knowledge provides a credible foundation for deciding what events mean and explaining them to others. Know your strengths and be willing to claim them. Accept that power is the ability to have an effect and be willing to realise that effect.
• Know what you want. Have a big agenda with a clear vision. Make up your own mind and take others with you.
• Practice the art of managing meaning by questioning accepted conventions, rearranging people’s perceptions, disrupting the status quo.
• Seek out advisory positions, advocating and influencing at the highest level in order to influence the public agenda.
• Make the undiscussible, discussible. Women can be very good at getting in their own way and silencing other women. It goes under headings like being nice and being unwilling to take responsibility. Sense-making leaders are willing to discuss and act on such issues as under-performance and unacceptable behaviour.
• Support your leaders. Women have subtle and not so subtle ways of making other women uncomfortable with exercising their leadership. We can hobble would-be leaders by placing too much emphasis on unhelpful comparisons, by worrying too much about what others might think, and by being too narrow in our thinking about what success, competition and confrontation mean.

Handling ambiguity

Let’s look more closely at ambiguity. Ambiguity is perceived when a person sees more than one meaning in a situation and can’t decide which to accept. Ambiguous behaviour creates speculation, fear and worst-case thinking.

What behaviours can generate ambiguity? Here’s three to consider.

• Making a decision without explaining the rationale. People expect leaders to make decisions but if the underlying reasons or logic are unclear then acceptance of the decision can be difficult.
• Not responding to suggestions. When staff provide their ideas, particularly when invited to do so, and there’s no sign as to what became of those ideas, doubts and disappointment are generated, and people may assume the worst. If their input is not reflected in a decision or consultation process people feel cheated. Repeated offences build cynicism and destroy trust. ‘Why bother?’ they’ll think, ‘What’s the point? Management is only going through the motions again.’
• Sending mixed messages summed up in the cliché ‘Do as I say not as I do.’ People become worried and cynical when inconsistent or mixed messages are observed. For example, you tell people performance appraisal is important but do not conduct them on time. Or you encourage people to use their discretion but also let them know mistakes are not desirable.

The sense-maker is a role model explaining decisions and how suggestions were handled, and minimising mixed messages. Communication myths that impede sense-making

Some myths about communication can hinder the sense-making leader. Here’s two of these myths.

• Thinking that clear communication is an attainable goal. While clear communication is something to work at, there is probably never going to be a time when things aren’t misinterpreted to some degree. Expecting otherwise is an illusion. You can reduce ambiguity, but not eliminate it.
• Believing a good flow of information means understanding. Just keeping information flowing doesn’t mean people have understood it. That’s a separate exercise requiring sense-making.

Actions that help build trust, understanding and credibility include:

• Doing your fair share of the mundane, such as loading paper in photocopier, making coffee, answering phones.
• Deciding what information can be shared and with whom, based on laws, regulations and ethics. Then explaining this to others.
• Explaining the pressures and political realities that create competing demands. Knowing this information helps people appreciate that circumstances are not as black-and-white as they may seem.
• Being clear about how a decision will be made and the nature of the decision. Is a decision to be made by the team, by one person, by consensus, by voting? Is the decision about a broad, perhaps vague, issue (e.g. opinions about the team’s budget) or do you want a response to a specific matter (e.g. is the amount allocated for staff training realistic)?

Sense-making, viability and visibility

The aim of the conference was to increase the viability and visibility of the nursing profession. What then, is the link between sense-making, visibility and viability?

Visibility depends on the ability to make sense of the nursing world for others, both within and without the profession. How are leaders managing expectations about the diverse roles of nurses? How are key players going to understand the language of nursing and the boundaries with other health professionals? How will leaders handle change and guide their colleagues into unfamiliar territory?

Viability depends on how convincing this sense-making is compared with competing sense-makers. How are leaders interpreting the role of nurses? How are they providing leadership in health care and on health care issues? How will nursing leaders ensure that they influence the public debate on health care?

Visibility and viability are linked. It is hard to remain viable if no one sees or hears you. When nursing leaders act as sense-makers they create a rich, rewarding and more stable environment and offer a voice for the future of the profession.

First published in Nursing Review.